Costs and benefits of different methods of esophagectomy for esophageal cancer

Abstract

Background A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery. Methods The data of 83 consecutive patients who underwent a McKeown's esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach. Results Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy ( p = 0.02), but these patients reported less postoperative pain ( p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy ( p = 0.01), but there were no significant differences in inpatient care and total hospital costs. Conclusion Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.

Minimally invasive techniques for transthoracic oesophagectomy for oesophageal cancer: systematic review and network meta-analysis

“…The review identified 98 studies 6,7,34–129 comparing surgical approaches for oesophagectomy, involving 32 315 patients ( Fig . 1 ).…”

Efficacy of hybrid minimally invasive esophagectomy vs open esophagectomy for esophageal cancer: A meta-analysis

“…A total of 17 studies, including 2 RCTs[8,9] and 15 case-control studies[10-24], were eligible for the meta-analysis. The studies included 2397 esophageal carcinoma patients, of which 1170 received HMIE and 1227 underwent OE.…”

“…Smithers et al[12] reported that patients who underwent HMIE had less blood loss than those undergoing OE, while Yanasoot et al[24] showed no significant difference. In our meta-analysis also, the total HMIE group and the HMIE with laparoscopy and thoracotomy group had less blood loss, which could be attributed to the relatively minimal trauma in HMIE.…”

Feasibility and efficiency of concurrent chemoradiotherapy with capecitabine and cisplatin versus radiotherapy alone for elderly patients with locally advanced esophageal squamous cell carcinoma: Experience of two centers

“…Esophageal cancer is the eighth most common cancer worldwide and the overall prognosis for patients is still poor . While esophageal adenocarcinoma has emerged as the major histological subtype in Western countries, squamous cell carcinoma is the more common histology in certain geographic areas, including Brazil, northern China, Iran, Russia, and South Africa .…”